{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T19:31:53Z","timestamp":1772998313457,"version":"3.50.1"},"reference-count":58,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,12,6]]},"abstract":"<jats:p>Well-defined locations of pemphigus cases support the hypothesis of environmental factors\u2019 involvement in its etiopathogenesis; however, these foci have never been described using specialized geographical tools. This is the first report to geo-reference pemphigus cases in a high-prevalence Brazilian region using geographic information systems. We aimed to report the spatio-temporal behavior of pemphigus foliaceus (PF) and vulgaris (PV) in southeastern Brazil, over the last five decades to describe geographical clusters, as well as to characterize the land use in the city with the highest number of cases. Patients were identified from 1965 to 2014. Maps were developed using ArcGIS software and organized into decades from 1965 to 2014. Ribeir\u00e3o Preto was identified as the city with the greatest number of cases. Land use was analyzed within a 2 km-buffer surrounding the residence of each patient. A total of 426 cases of pemphigus were identified. PF was the predominant form (285 cases); notwithstanding, the number of new cases of PV rose, overtaking the number of new cases of PF in the last decade studied. Agricultural area (42%) and exposed soil (33.2%) are the most predominant land uses in Ribeir\u00e3o Preto surrounding patients\u2019 residences. This study shows high-confidence geographical foci of PF and PV, as well as provides evidence of an increase of both clinical forms over the last five decades. All cases of PV and PF are in proximity to rivers and agricultural areas which reinforce the hypothesis that environmental factors play a role in pemphigus etiopathogenesis.<\/jats:p>","DOI":"10.4269\/ajtmh.17-0100","type":"journal-article","created":{"date-parts":[[2017,9,26]],"date-time":"2017-09-26T07:00:35Z","timestamp":1506409235000},"page":"1737-1745","source":"Crossref","is-referenced-by-count":13,"title":["Spatial Distribution of Pemphigus Occurrence over Five Decades in Southeastern Brazil"],"prefix":"10.4269","volume":"97","author":[{"given":"Beatriz Smidt","family":"Celere","sequence":"first","affiliation":[{"name":"Department of Maternal-Infant Nursing and Public Health, University of S\u00e3o Paulo, Ribeir\u00e3o Preto, S\u00e3o Paulo, Brazil;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sebastian","family":"Vernal","sequence":"additional","affiliation":[{"name":"Division of Dermatology, Department of Clinical Medicine, Ribeir\u00e3o Preto Medical School, University of S\u00e3o Paulo, Ribeir\u00e3o Preto, S\u00e3o Paulo, Brazil;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leonardo","family":"La Serra","sequence":"additional","affiliation":[{"name":"Division of Dermatology, Department of Clinical Medicine, Ribeir\u00e3o Preto Medical School, University of S\u00e3o Paulo, Ribeir\u00e3o Preto, S\u00e3o Paulo, Brazil;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Jos\u00e9","family":"Franco Brochado","sequence":"additional","affiliation":[{"name":"Division of Dermatology, Department of Clinical Medicine, Ribeir\u00e3o Preto Medical School, University of S\u00e3o Paulo, Ribeir\u00e3o Preto, S\u00e3o Paulo, Brazil;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luiz Eduardo","family":"Moschini","sequence":"additional","affiliation":[{"name":"Department of Environmental Sciences, Center for Biological and Health Sciences, Federal University of S\u00e3o Carlos, S\u00e3o Carlos, S\u00e3o Paulo, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana Maria","family":"Roselino","sequence":"additional","affiliation":[{"name":"Division of Dermatology, Department of Clinical Medicine, Ribeir\u00e3o Preto Medical School, University of S\u00e3o Paulo, Ribeir\u00e3o Preto, S\u00e3o Paulo, Brazil;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susana In\u00e9s","family":"Segura-Mu\u00f1oz","sequence":"additional","affiliation":[{"name":"Department of Maternal-Infant Nursing and Public Health, University of S\u00e3o Paulo, Ribeir\u00e3o Preto, S\u00e3o Paulo, Brazil;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Environ Res","first-page":"75","article-title":"The application of GIS in environmental health sciences: opportunities and limitations","volume":"71","author":"Tim","year":"1995"},{"key":"b2","series-title":"Parasitology","first-page":"401","article-title":"Application of GIS technology in public health: successes and challenges","volume":"143","author":"Fletcher-Lartey","year":"2016"},{"key":"b3","series-title":"Annu Rev Pathol","first-page":"175","article-title":"Mechanisms of disease: pemphigus and bullous pemphigoid","volume":"11","author":"Hammers","year":"2016"},{"key":"b4","series-title":"Clin Dermatol","first-page":"374","article-title":"Pemphigus: etiology, pathogenesis, and inducing or triggering factors: facts and controversies","volume":"31","author":"Ruocco","year":"2013"},{"key":"b5","series-title":"Arch Dermatol Res","first-page":"291","article-title":"Geographic variations in epidemiology of two autoimmune bullous diseases: pemphigus and bullous pemphigoid","volume":"307","author":"Alpsoy","year":"2015"},{"key":"b6","series-title":"Int J Dermatol","first-page":"477","article-title":"Historical notes on endemic pemphigus in South America","volume":"51","author":"Chac\u00f3n","year":"2012"},{"key":"b7","series-title":"N Am J Med Sci","first-page":"51","article-title":"Endemic pemphigus foliaceus over a century: part I","volume":"2","author":"Abr\u00e9u-V\u00e9lez","year":"2010"},{"key":"b8","series-title":"J Invest Dermatol","first-page":"4","article-title":"Endemic pemphigus foliaceus (Fogo Selvagem): II. 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